Codeine intoxication associated with ultrarapid CYP2D6 metabolism by Gasche Yvan, Daali Youssef, Fathi Marc, Chiappe Alberto, Cottini Silvia, Dayer Pierre, Desmeules Jules in The New England journal of medicine (2004). PubMed


Life-threatening opioid intoxication developed in a patient after he was given small doses of codeine for the treatment of a cough associated with bilateral pneumonia. Codeine is bioactivated by CYP2D6 into morphine, which then undergoes further glucuronidation. CYP2D6 genotyping showed that the patient had three or more functional alleles, a finding consistent with ultrarapid metabolism of codeine. We attribute the toxicity to this genotype, in combination with inhibition of CYP3A4 activity by other medications and a transient reduction in renal function.

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